Chapter 10: Echocardiography in acute mitral regurgitation

The presence of a clear structural abnormality of the mitral valve on echo (such as a flail leaflet with the tip of the leaflet appearing in the left atrium during systole) predicts severe mitral regurgitation, even if the color Doppler appearance is ambiguous. Conversely, the absence of any identifiable morphologic abnormality makes severe regurgitation unlikely.
Apart from the proximal jet width (vena contracta), a well-formed, large, consistently imaged proximal acceleration zone on the ventricular side of a mitral regurgitant lesion or systolic retrograde pulmonary venous flow predicts severe regurgitation. High E-waves and increased pulmonary pressures are also regularly present.
Definitive evaluation of regurgitation in a prosthetic mitral valve usually requires transesophageal imaging.

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